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Chapter 17 The Final Challenge: Death and Dying

Chapter 17 The Final Challenge: Death and Dying. Biological Definitions of Death. Harvard: Total Brain Death Unresponsive to stimuli No movement or breathing No reflexes Flat EEG Euthanasia: “happy” or “good” death Hastening death of someone suffering incurable illness or injury.

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Chapter 17 The Final Challenge: Death and Dying

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  1. Chapter 17The Final Challenge:Death and Dying

  2. Biological Definitions of Death • Harvard: Total Brain Death • Unresponsive to stimuli • No movement or breathing • No reflexes • Flat EEG • Euthanasia: “happy” or “good” death • Hastening death of someone suffering incurable illness or injury

  3. Social Meanings of Death • Modern American • Medical failure • More traditional societies • Natural part of life cycle • Grieving practices vary • By culture: weeping/partying • By ethnicity: wake/Shiva

  4. Life Expectancy • Expected age at death • U.S.: 76.5 years • White females: 80 years • White males: 75 years • Black females: 75 years • Black males: 68 years • Ancient Rome: 30 years

  5. Figure 17.1

  6. Theories of Aging and Death • Programmed theories • Maximum life span (species specific) • Hayflick Limit • Damage Theories • Free radicals • Interaction of the two – or more

  7. Kubler-Ross’s Stages of Dying • Common set of stage-like emotions • Denial, anger, bargaining, depression, acceptance • Criticisms • Not a stage-like process • Course of illness not considered • Individual differences

  8. Attachment Model of Bereavement • Bereavement: the state of loss • Grieving: emotional expressions • Anticipatory grief • Mourning: culturally approved reactions • Parks/Bowlby Model • Reaction to separation from a loved one • Numbness, yearning, despair, reorganization

  9. Figure 17.2

  10. The Infant • Object permanence • Attachment by 6-8 months • Separation anxiety at loss • Protest, yearning, searching despair • Behavioral: eating, sleeping, regression • Less distress if attached to other parent • Eventual new attachments and recovery

  11. The Child • The mature concept of death • Finality, irreversibility, universality, biological causality • Age 3-5: universality • Dead live under altered circumstances • Reversible - life sleep • Age 5-7: finality, irreversibility • Level of cognitive development, experience

  12. The Dying Child • Young child aware of impending death • Adults often secretive • Same range of emotions as dying adults • Anxiety revealed in behavior • Parental control is helpful • Need support of important others

  13. The Bereaved Child • Children do grieve • Express grief differently than adults do • Misbehavior, strike out, rage • Lack adult coping skills • Will use denial, avoidance • Most adjust successfully

  14. The Adolescent • Higher levels of understanding • Concerns of adolescence • Body image, identity, independence • May carry on internal dialogue with dead • Devastated at death of close friend • Adult-like grieving

  15. The Adult • Death of family member difficult • Death of spouse more expected with age • More difficult when young (non-normative) • Elevated levels of stress • Risk increases for illness and death • Signs of recovery after 2 years

  16. Loss of a Child • No loss more difficult • Experienced as untimely, unjust • Broken attachments • Guilt at failure to protect child • May continue relationship w/dead child • Marital problems often increase afterward

  17. The Loss of a Parent • Lasting problems may occur if young • Less tragic than unexpected death • Adjustment not as difficult • Guilt: not doing enough for parent • Broken attachment

  18. Grief Work Perspective • Emotions must be confronted: detachment • Psychoanalytic, also popular view • May be a culturally biased belief • Grief work may actually cause more distress • Delayed grief reaction predicted w/out it • Not supported by research • Detachment not necessary

  19. Who Copes and Who Succumbs • Secure infant attachment related to coping • Low self-esteem related to more difficulty • Cause of death influences bereavement • Support system essential • Additional life stressors detrimental • Positive outcomes often found

  20. Hospice • Dying person decides what is needed • De-emphasize prolonging life • Pain control emphasized • Normal setting (if possible) • Bereavement counseling for entire family • Research shows positive outcomes

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